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ANESTHETIC PROBLEMS AND EMERGENCIES

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ANESTHETIC PROBLEMS AND EMERGENCIES CHAPTER 12 Every anesthetic procedure has the potential to cause death of the animal ... – PowerPoint PPT presentation

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Title: ANESTHETIC PROBLEMS AND EMERGENCIES


1
ANESTHETIC PROBLEMS AND EMERGENCIES
  • CHAPTER 12
  • Every anesthetic procedure has the potential to
    cause death of the animal

2
  • Emergencies are uncommon and the overwhelming
    majority of patients recover from anesthesia with
    no ill lasting effects

3
WHY,WHY,WHY DO ANESTHETIC PROBLEMS AND
EMERGENCIES ARISE?
  • 1. HUMAN ERROR!

4
HUMAN ERROR
  • FAILURE TO OBTAIN AN ADEQUATE HISTORY OR PHYSICAL
    EXAMINATION ON THE PATIENT.
  • Ideally, every patient scheduled for anesthesia
    should have a complete physical examination, and
    a thorough history should be obtained with the
    owner present.
  • Less than ideal circumstances are common
  • Owner drops patient off in a hurry
  • Patient brought in by neighbor or friend
  • Receptionist takes the history
  • Physical exam is cursory or omitted

HISTORY?
PHYSICAL?
5
HUMAN ERROR
  • LACK OF FAMILIARITY WITH THE ANESTHETIC MACHINE
    OR DRUGS USED

The confident, knowledgeable, experienced RVT!
The not so confident kennel worker who was asked
to assist in surgery today.
6
HUMAN ERROR
  • INCORRECT ADMINISTRATION OF DRUGS
  • INACCURATE WEIGHT
  • MATHEMATICAL ERRORS
  • USE OF WRONG MEDICATION
  • Be aware of medications that come in different
    concentrations
  • ADMINISTRATION OF MEDS BY INCORRECT ROUTE
  • knowledge of pharmacology
  • drugs with narrow margin of safety
  • CONFUSION BETWEEN SYRINGES
  • ALWAYS LABEL SYRINGES
  • USE OF INAPPROPRIATE SYRINGE SIZE

7
HUMAN ERROR
  • PRESSURES AND DISTRACTIONS
  • Feeling hurried or rushed
  • Distraction because of ineffective multi-tasking
  • Fatigue
  • Inattentiveness
  • Be proactive, rather than reactive!
  • Recognize early signs of trouble
  • Pay attention to patient and machines

8
WHY,WHY,WHY DO ANESTHETIC PROBLEMS AND
EMERGENCIES ARISE?
  • 2. EQUIPMENT FAILURE
  • In many cases the failure of the machine is in
    fact a failure of the operator.

9
EQUIPMENT FAILURE
  • CO2 ABSORBER EXHAUSTION
  • In re-breathing systems, if CO2 is not
    removed from the circuit, the patient will
    experience hypercapnia.
  • In a non re-breathing system, if the gas flow
    is too low, there may also be a significant
    re-breathing of expired gases.
  • ? CO2 Tachypnea, tachycardia, brick red
    mucous membranes, cardiac arrhythmias,
    respiratory acidosis
  • Human error!

10
EQUIPMENT FAILURE
  • INSUFFICIENT O2 FLOW
  • You will need to check both the flowmeter and the
    oxygen tank pressure gauge.
  • Oxygen tank runs out
  • Hose becomes disconnected
  • Obstruction or leak occurs
  • If the oxygen flow stops while the patient is
    hooked up to a non re-breathing system, the
    anesthetist should disconnect the hose from the
    Endotracheal tube, allowing the patient to
    breathe room air.
  • If a re-breathing (circle) system is being used,
    the patient can remain connected for a short
    period of time, provided the reservoir bag
    remains inflated.
  • Human Error

11
EQUIPMENT FAILURE
  • ANESTHETIC MACHINE MISASSEMBLED
  • Take time to learn and follow the direction and
    path of gas flow within the machine. Every time a
    connection is added or removed, the anesthetist
    should ensure that the correct pattern of flow is
    maintained and that all connections are secure.
  • Soda-Lyme container main leak

12
EQUIPMENT FAILURE
  • ENDOTRACHEAL TUBE PROBLEMS
  • BLOCKED TUBES
  • Twisting or kinking of the tube (inappropriate
    positioning)
  • Accumulation of material such as blood, saliva,
    excess lubricant
  • Tube advanced too far into a bronchus
  • CHECK TUBE FUNCTION
  • BAG the patient watch for chest rising
  • Disconnect the patient feel for air coming out
    of the tube when the patients chest is
    compressed
  • If an accumulation of material is causing the
    obstruction, it may be helpful to suction with a
    syringe through a red-rubber catheter or feeding
    tube.

13
EQUIPMENT FAILURE
  • VAPORIZER PROBLEMS
  • Wrong anesthetic in the vaporizer
  • Vaporizer is empty
  • Do not tip the vaporizer could result in
    leakage into the oxygen bypass
  • Vaporizer dial may be jammed
  • Dont overfill the vaporizer

14
EQUIPMENT FAILURE
  • POP-OFF VALVE PROBLEMS
  • The pop-off valve is inadvertently left closed
  • Closed pop-off valve ?pressure rises in the
    circuit ?reservoir bag expands, as well as the
    patients lungs ?exhalation is prevented
  • This can lead to decreased cardiac output, low
    blood pressure, and death.
  • If pressure rises in the circuit and the bag is
    full and tight, the anesthetist should attempt to
    open the pop-off valve and/or decrease the oxygen
    flow rate.

15
WHY,WHY,WHY DO ANESTHETIC PROBLEMS AND
EMERGENCIES ARISE?
  • 3. ANESTHETIC AGENTS
  • Every injectable or inhalation agent has the
    potential to harm a patient and, in some cases,
    cause death. Review the description of the
    pharmacologic and physiologic effects of
    pre-anesthetic and general anesthetic agents in
    chapters 1 and 3.

16
WHY,WHY,WHY DO ANESTHETIC PROBLEMS AND
EMERGENCIES ARISE?
  • 4. PATIENT FACTORS

pre-operative status
age
concurrent disease
breed
17
PATIENT FACTORS
  • GERIATRIC PATIENTS
  • (75 of life expectancy)
  • POTENTIAL PROBLEMS
  • Reduced organ function- liver, kidney, heart
  • Poor response to stress
  • At risk for degenerative disorders- diabetes,
    CHF, cancer
  • Increased risk for hypothermia and overhydration
  • Prolonged recovery

18
Geriatric Patients solutions
  • POTENTIAL SOLUTIONS
  • Reduce anesthetic dosages
  • Increase preanesthetic blood work from mini to a
    general profile, include u/a, x-rays, ECG if
    needed
  • Allow a longer time for response to drugs
  • Reduce fluid rate
  • Keep patient warm
  • Choose anesthetic agents with minimal CV effects
  • Pre-oxygenate

19
PATIENT FACTORS
  • PEDIATRIC PATIENTS
  • (lt3 months)
  • POTENTIAL PROBLEMS
  • Increased risk for hypothermia and overhydration
  • Increased risk of hypoglycemia, hypotension,
    Bradycardia
  • Inefficient excretion of drugs-reduced kidney and
    liver function
  • Difficult intubation
  • Difficult IV cath placement
  • POTENTIAL SOLUTIONS
  • Be proactive about heat preservation
  • Avoid prolonged fasting (/- 5 dextrose
    administration)
  • Reduce anesthetic dosages
  • Use a gram scale to weigh
  • Use inhalant anesthetics

20
PATIENT FACTORS
  • BRACHYCEPHALIC DOGS
  • POTENTIAL PROBLEMS
  • Conformational tendency toward airway obstruction
  • Elongated soft palate
  • Small nasal openings
  • Hypoplastic trachea
  • Difficult to intubate
  • Abnormally high vagal tone
  • Bradycardia
  • POTENTIAL SOLUTIONS
  • Use an anticholinergic
  • Pre-oxygenate
  • Induce rapidly with IV agents
  • Delay extubation
  • Close monitoring during recovery- recover in a
    excitement free area

21
PATIENT FACTORS
  • SIGHTHOUNDS
  • POTENTIAL PROBLEMS
  • Increased sensitivity to barbiturates
  • Lack of body fat for redistribution/elimination
  • of the drug
  • POTENTIAL SOLUTIONS
  • Use alternative agents

22
PATIENT FACTORS
  • OBESE PATIENTS
  • POTENTIAL PROBLEMS
  • Accurate dosing is difficult- lower dose /kg
  • Poor distribution of drugs
  • Respiratory difficulty- shallow rapid
    respirations during anesthesia
  • POTENTIAL SOLUTIONS
  • Dose according to ideal weight
  • Pre-oxygenate
  • Induce rapidly
  • Delay extubation
  • Close monitoring during recovery

23
PATIENT FACTORS
  • CESAREAN PATIENTS- normally an emergency
  • POTENTIAL PROBLEMS
  • DAM increased workload to heart
  • Respiration compromised
  • Increased risk of hemorrhage- shock/hypotension
  • Increased risk of vomiting/regurgitation- not
    normally fasted
  • Hypoxemia
  • Hypercarbia
  • Acid/base imbalance
  • Tissue trauma
  • Cardiac arrhythmias
  • OFFSPRING susceptibility to the effects of the
    anesthetic agents (reduced Cardio and Respiratory
    function)

24
Cesarean patients
  • POTENTIAL SOLUTIONS
  • DAM IV fluids
  • Clip patient before induction, in lateral
    recumbency
  • Pre-oxygenate
  • Reduce anesthetic dosages
  • OFFSPRING use doxapram and/or atropine
  • aspirate fluids from mouth
  • Administer oxygen via face mask, intubate with 18
    or 16g IVC
  • Keep warm
  • Encourage nursing

25
Patient Factors
  • TRAUMA PATIENTS
  • POTENTIAL PROBLEMS
  • Respiratory distress common- decrease in tidal
    volume, increase in CO2
  • Cardiac arrhythmias
  • Shock and hemorrhage- hypotension
  • Internal injuries
  • POTENTIAL SOLUTIONS
  • Stabilize patient if possible
  • Obtain chest rads, ECG
  • Check for other concurrent injuries

26
Anesthetic Problems and Emergencies Patient
Factors
  • Change in blood pressure
  • Resulting from a change in cardiac output or
    vascular tone
  • Anesthetic depth will affect both parameters
  • Hypotension ? decreased tissue perfusion ? tissue
    hypoxia/anoxia ? anaerobic glycolysis ? lactic
    acid production ? acid/base imbalance
  • Monitor blood pressure closely
  • Doppler or oscillometric methods
  • Digital pulse palpation
  • Capillary refill time

27
TREATMENT OF HYPOTENSION
  • REDUCE ANESTHETIC DEPTH
  • PRESERVE WARMTH
  • FLUID THERAPY- SHOCK RATE
  • ADMINISTRATION OF EMERGENCY DRUGS
  • Corticosteroids
  • Sodium bicarbonate
  • Cardiac inotropes (dopamine, dobutamine,
    ephedrine)

28
Fluid Therapy for Hypotension
  • Crystalloid fluid administration
  • May have to deliver small boluses for rapid
    therapy
  • Crystalloid fluids stay in intravascular space
    lt2 hours
  • Watch for fluid overload, especially in cats
  • Monitor heart rate, blood pressure, mucous
    membrane color, and capillary refill time

29
Fluid Therapy for Hypotension (Contd)
  • Colloid fluid administration
  • Helpful if blood pressure cant be maintained
  • Remain in the intravascular space longer than
    crystalloids
  • Will increase colloidal osmotic pressure and help
    stabilize blood pressure
  • Given in smaller volume in conjunction with
    crystalloids
  • Hetastarch, Dextran 40 or 70, 10 Pentastarch,
    plasma, whole blood

30
  • Respiratory problems in the trauma patient
  • Direct trauma to the chest leading to lung
    collapse or failure of alveolar gas exchange
  • Must remove air/fluid from chest cavity prior to
    anesthesia
  • Deliver supplemental oxygen
  • Oxygen delivery methods
  • Flow-by-oxygen
  • Nasal catheters
  • Oxygen collars

31
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32
Thoracocentesis (Chest Tap)
  • To relieve pneumothorax or pleural effusion from
    chest cavity
  • Performed by veterinarian Prepped by veterinary
    technician
  • Temporary bandage over chest wound
  • Place animal in sternal recumbency or standing
    position
  • Shave lateral chest wall between the 7th and 9th
    intercostal spaces caudal to point of the elbow
  • Aseptically prepare 4 cm 4 cm area
  • Prepare a 20- to 22-gauge, 1- to 1½-inch catheter
    with a three-way stopcock and large syringe
  • video

33
PATIENT FACTORS
  • CARDIOVASCULAR DISEASE
  • POTENTIAL PROBLEMS
  • Circulation compromised
  • Pulmonary edema common
  • Increased tendency to develop arrhythmias and
    tachycardia
  • POTENTIAL SOLUTIONS
  • Alleviate pulmonary edema (diuretics)
  • Pre-oxygenate
  • Avoid agents that may cause arrhythmias
  • Prevent overhydration- cut fluids in 1/2

34
  • Preexisting cardiovascular disease
  • Anemia
  • Shock
  • Cardiomyopathy (primary or secondary)
  • Congestive heart disease (mitral valve
    insufficiency)
  • Heartworm disease
  • Coexisting imbalances (e.g., hypoxia,
    hypercapnia, electrolyte imbalances)

35
  • Bradycardia
  • Most common cardiac anesthetic problem
  • Caused by preanesthetic or anesthetic drugs
  • Force of cardiac contraction may also be
    decreased
  • Blood return to the heart may be decreased
    (preload)
  • Treat with drugs or adjustment of anesthetic
    depth

36
  • Cardiac arrhythmias
  • Caused by anoxia/hypercarbia, poor tissue
    perfusion, acid/base imbalance, myocardial damage
  • Difficult to detect on physical examination may
    find dropped beats
  • Diagnose with ECG and report immediately to
    veterinarian who will determine the treatment
    required
  • Concurrent pulmonary disease is sometimes seen

37
PATIENT FACTORS
  • RESPIRATORY DISEASE
  • POTENTIAL PROBLEMS
  • Poor oxygenation of tissues
  • Patient may be anxious and difficult to restrain
  • Increased risk of respiratory arrest
  • POTENTIAL SOLUTIONS
  • Avoid unnecessary handling
  • Pre-oxygenate
  • Induce with injectable agents
  • Intubate rapidly control ventilation
  • Monitory closely during recovery

38
  • Respiratory disease
  • Caused by
  • Pleural effusion Diaphragmatic hernia
  • Pneumothorax Pneumonia
  • Tracheal collapse Pulmonary edema
  • Clinical signs
  • Tachypnea
  • Dyspnea
  • Cyanosis

39
  • Anesthetic considerations
  • VT is reduced and respiratory rate is decreased
    in most anesthetized animals
  • A decrease in VT will result in a decreased
    alveolar gas exchange
  • Lighten anesthesia as much as possible in a
    patient with respiratory disease
  • Provide intermittent ventilation
  • Evaluate oxygen-carrying capacity with PCV or
    pulse oximeter
  • Preoxygenation is necessary prior to induction

40
Diaphragmatic Hernia
  • Dysnpnea- pre oxygenate
  • Avoid head down positions
  • Intubate rapidly
  • bagging patient
  • Pay close attention to pulse ox, capnograph, and
    do a arterial blood gas if available.

41
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42
PATIENT FACTORS
  • HEPATIC DISEASE
  • POTENTIAL PROBLEMS
  • Liver necessary for drug metabolism, blood
    clotting factors, plasma proteins, carbohydrate
    metabolism
  • Decreased synthesis of clotting factors
  • Possibly hypoproteinemic
  • Dehydration common
  • Anemic and/or icteric
  • Prolonged recovery
  • POTENTIAL SOLUTIONS
  • Pre-anesthetic blood work
  • Preanesthetic agents must be chosen with care
  • Use inhalant anesthetics
  • Close monitoring during recovery
  • Preanesthetic agents must be chosen with care

43
PATIENT FACTORS
  • RENAL DISEASE
  • POTENTIAL PROBLEMS
  • Delayed excretion of anesthetic agents
  • Electrolyte imbalances common
  • Dehydration may be present
  • POTENTIAL SOLUTIONS
  • Pre-anesthetic blood work
  • Rehydrate before surgery
  • Reduce anesthetic dosages
  • IV fluids

44
  • Renal disease
  • Kidneys maintain volume and electrolyte
    composition of body fluids
  • Renal excretion removes anesthetic agents and
    metabolites from the body
  • General anesthesia is associated with decreased
    blood flow to the kidneys
  • Diagnosis urine specific gravity, BUN,
    creatinine
  • Offer water up to 1 hour prior to premedication
  • Correct dehydration prior to anesthesia

45
Anesthetic Problems and Emergencies Patient
Factors (Contd)
  • Urinary blockage
  • Clinical signs
  • Depression
  • Dehydration
  • Uremia
  • Acidosis
  • Hyperkalemia (can lead to cardiac arrest)
  • Inhalation agents are less hazardous for the
    patient

46
ANESTHETIC PROBLEMS AND EMERGENCIES
Anesthetic problems will inevitably occur at
some point in your career. No anesthetic
experience is the same, so beware of the false
sense of security!
47
ANESTHETIC PROBLEMS AND EMERGENCIES
  • The Role of the Veterinary Technician in
    Emergency Care

48
ANIMALS THAT WILL NOT STAY ANESTHETIZED
  • Animals wont stay anesthetized
  • Check vaporizer setting
  • Check level of anesthetic in the vaporizer
  • Proper ET tube placement or air leakage around it
  • Patient apnea
  • Shallow respirations
  • Proper assembly of anesthetic machine with tight
    connections
  • Adequate oxygen flow
  • Anesthetic machine/vaporizer is working properly
  • Agonal breathing vs. light plane breathing

49
ANIMALS THAT ARE TOO DEEPLY ANESTHETIZED
  • Animals are too deeply anesthetized
  • lt6 bpm shallow respirations, dyspnea
  • Pale/cyanotic mucous membranes
  • Capillary refill time gt2 seconds
  • Bradycardia
  • Weak pulse systolic blood pressure lt80 mm Hg
  • Cardiac arrhythmias irregular QRS complexes or
    VPCs
  • Hypothermia
  • Absent reflexes
  • Flaccid muscle tone
  • Dilated pupils

50
TREATING EXCESSIVE ANESTHETIC DEPTH
  • ADJUST THE VAPORIZER
  • NOTIFY THE VETERINARIAN
  • BAG THE ANIMAL
  • 1. Close the pop-off valve
  • 2. fill the reservoir bag with oxygen
  • 3. gently squeeze the bag until the patients
    chest rises slightly (15-20 cm H2O)
  • 4. Repeat until animal shows signs of recovery

51
PALE MUCOUS MEMBRANES
  • Pale mucous membranes
  • Preexisting conditions
  • Blood loss during surgery
  • Anesthetic agent that causes vasodilation and
    hypotension
  • Hypothermia
  • Pain

52
TREATMENT OF PALE MUCOUS MEMBRANES
  • Ascertain the animals anesthetic depth
  • HR, RR, pulse quality, CRT
  • Consult the veterinarian
  • Fluids, blood transfusion

53
Anesthetic Problems and Emergencies (Contd)
  • Prolonged capillary refill time (gt2 seconds)
  • Blood pressure cannot adequately perfuse
    superficial tissues
  • May result from conditions present prior to
    induction
  • May be secondary to blood loss during surgery
  • May be seen in animals in deep anesthesia

54
DYSPNEA AND/OR CYANOSIS
  • DYSPNEA respiratory difficulty
  • CYANOSIS bluish coloration of the mucous
    membranes indicating inadequate tissue
    oxygenation
  • Assessment
  • Respiratory character and volume
  • Depth of anesthesia
  • Associated with pain
  • Proper ET tube placement
  • ET tube blockage
  • Oxygen saturation
  • Arterial or end-tidal CO2

55
Treatment of cyanosis/dyspnea
  • 1. Check O2 flow meter
  • 2. Turn off vaporizer and begin to bag the
    patient (IPPV)
  • If the anesthetic machine is unavailable, an Ambu
    bag can be used to deliver room air
  • 3. Reintubate if necessary
  • 4. Continue until patient improves
  • 5. Close monitoring to ensure that cardiac arrest
    does not occur
  • Radiographs and thoracocentesis might be needed

56
TACHYPNEA
  • TACHYPNEA rapid respirations
  • CAUSES
  • Surgical stimulation
  • Commonly seen with opioid use
  • Associated with light anesthesia accompanied by
    tachycardia and spontaneous movement
  • May be seen in hyperthermic animals

57
TREATMENT OF TACHYPNEA
  • CHECK ANESTHETIC DEPTH
  • Is the animal too light?
  • CAPNOGRAPH READING
  • Obese patients
  • Assist or control ventilation

58
RESPIRATORY ARREST
  • Not all cases require immediate action by the
    anesthetist
  • Cessation of respiratory efforts
  • Can lead to cardiac arrest
  • Temporary arrest
  • May follow injection of respiratory depressants
    or following a period of prolonged bagging
  • Evaluate other vital signs
  • HR/pulse quality
  • MM
  • ECG
  • Pulse oximeter reading

59
  • Respiratory arrest (Contd)
  • True arrest
  • Requires immediate action
  • Can result from anesthetic overdose, cessation of
    oxygen flow, or preexisting respiratory disease
  • May be preceded by dyspnea or cyanosis and
    abnormal vital signs
  • May use Ambu bag, mouth-to-ET tube, or
    mouth-to-muzzle resuscitation

60
Use of an Ambu Bag
61
TREATMENT OF TRUE RESPIRATORY ARREST
  • 1. NOTIFY THE VETERINARIAN
  • 2. Turn off the vaporizer
  • 3. Place ET tube if not already done
  • Emergency tracheotomy? http//www.youtube.com/watc
    h?v3doQewrHdhQ
  • 4.Monitor for cardiac arrest
  • 5.Restore oxygen flow and begin bagging the
    patient
  • 6. Continue bagging every 5 seconds until vital
    signs improve
  • 7. Administer shock fluids
  • 8. Preserve warmth

62
CARDIAC ARREST
  • Cardiac arrest
  • No heartbeat is auscultated or palpated
  • Normal QRS complexes are absent
  • No arterial pulse and blood pressure lt25 mm Hg
  • Gray or cyanotic mucous membranes
  • Widely dilated pupils, no corneal reflex
  • Agonal breathing
  • Some prior warning is usually present
  • Respiratory distress or arrest, cyanosis/dyspnea,
    prolonged capillary refill time, arrhythmia

63
CARDIAC ARREST - ABCDEF
  • There is a critical 4 MIN window to restore
    oxygen delivery to the brain!
  • Five people (ideal) involved
  • 1 performs chest compressions
  • 2 bags the animal
  • 3 assesses the pulse during compressions and
    checks the pulse or ECG when compressions are
    stopped
  • 4 draws up and administers drugs as per the
    veterinarians instructions
  • 5 maintains a record of the patients status and
    resuscitative treatment

64
Anesthetic Problems and Emergencies
  • Cardiac arrest with CPCR
  • A airway
  • B breathing
  • C circulation
  • D drugs
  • E ECG
  • Circulation is the most important step so the
    correct order is CABDE

65
CARDIAC ARREST - ABCDEF
  • AIRWAY and BREATHING
  • IMMEDIATELY CALL FOR HELP, NOTE THE TIME!
  • An Endotracheal tube must be placed!
  • Begin bagging at 1 breath every 10-12 seconds
  • Do not overinflate

66
CARDIAC ARREST - ABCDEF
  • CIRCULATION cardiac compressions should be
    initiated
  • POSITIONING right side down with feet toward the
    compressor
  • LARGE DOGS The heel of the compressors hand
    should compress the chest against a firm object
    placed under the dogs chest just behind the
    elbow. Also, dog can be placed in dorsal
    recumbency and compression applied to the caudal
    1/3 of the sternum

67
CARDIAC ARREST - ABCDEF
  • Medium sized dogs The chest is compressed
    between two hands, one underneath the chest and
    the other at the 5th intercostal space over the
    heart itself.
  • Small dogs or cats compression applied using the
    thumb to compress the chest against the fingers
    of the same hand.

68
  • Circulation
  • Most important factor is return of spontaneous
    circulation (ROSC)
  • Cardiac compressions
  • Method depends on the size of the animal
  • Compress chest about 1/3 the diameter of the
    chest wall
  • 1-2 compressions/second generates 100 bpm heart
    rate
  • Compressions manually force blood through the
    heart and into tissues
  • Each compression should produce a palpable
    femoral pulse

69
  • Circulation (Contd)
  • Bag the patient every 10-12 seconds
  • Simultaneously with compressions
  • Some results should be seen within 2 minutes
  • Internal compressions may be necessary
  • Resuscitation is unlikely to be successful after
    15 minutes
  • Once spontaneous cardiac contractions are
    established, continue bagging until spontaneous
    breathing is established (several hours)

70
These patients are not on their right side- boooo
71
CARDIAC ARREST - ABCDEF
  • Drugs
  • Veterinarian authorizes dosage, route, and nature
    of drugs
  • Catheterized animals
  • Drugs administered IV followed by rapid fluid
    administration
  • Be careful of overhydration
  • Injections into the base of the tongue or by the
    intratracheal route are the second choice
  • Intracardiac injections should be avoided

72
  • Commonly used drugs
  • Epinephrine
  • Cardiac arrest
  • Vasopressin
  • In place of or alternated with epinephrine
  • Atropine
  • Anesthesia-related cardiac arrest
  • Dopamine or dobutamine
  • Increase force and rate of cardiac contractions

73
  • Monitor cardiovascular and respiratory function
  • Blood pressure, blood gases, pulse oximetry, ECG,
    capnography
  • Drug and fluid therapy varies
  • Assess brain function
  • Repeat arrest within 24 hours is common
  • Following successful ROSC, other conditions may
    arise
  • Pulmonary or cerebral edema

74
CARDIAC ARREST - ABCDEF
  • ECG
  • Periodically check for spontaneous contractions
    by discontinuing external compression and either
    palpating for a pulse or looking for QRS
    complexes on the ECG.
  • Differentiate between different forms of cardiac
    arrest to more effectively pick the treatment

75
  • ECG
  • Dont use alcohol if a defibrillator is present
  • Asystole
  • No electrical activity
  • Ventricular fibrillation
  • Coarse vertical zig-zag lines resulting from
    disorganized muscular heart activity
  • Pulseless electrical activity (electromechanical
    dissociation, EMD)
  • Normal or near-normal complexes

76
  • Regurgitation during anesthesia
  • A passive process under anesthesia
  • No retching, just fluid draining from animals
    mouth or nose
  • Stomach contents may be aspirated into
    respiratory tract
  • Most common occurrence in head-down surgical
    positions and in ruminants
  • Treatment
  • Immediate placement of cuffed ET tube
  • Clean out regurgitated material with suction

77
  • Vomiting during or after anesthesia
  • Common in brachycephalic dogs or nonfasted
    animals
  • An active process usually accompanied by retching
  • Usually occurs as the animal is losing or
    regaining consciousness
  • Signs
  • Airway obstruction leading to dyspnea/cyanosis,
    bronchospasm
  • Treatment
  • Intubation and suction if unconscious
  • Lower head and clean oral cavity if conscious

78
  • Seizures
  • Seen with ketamine administration, after
    diagnostic procedures (myelography), or
    preexisting conditions
  • Signs
  • Spontaneous twitching uncontrolled movements of
    head, neck, and limbs opisthotonus triggered by
    a stimulus
  • Treatment
  • Reduce stimuli, postoperative analgesia, diazepam
    or propofol, monitor for hyperthermia

79
  • Excitement
  • Seen after barbiturate anesthesia or high opioid
    doses, as spontaneous paddling and vocalization
  • Treatment may not be necessary
  • Sedatives may help
  • Naloxone can reverse opioids
  • Seizures should be differentiated from excitement

80
  • Dyspnea in cats
  • Dyspnea is usually caused by laryngospasm
    sometimes triggered by removal of the ET tube
  • Laryngeal edema may result from repeated
    intubation attempts
  • May breathe with an audible stertor (wheeze)
    during inspiration
  • Differentiate from growling during expiration
  • May resolve itself or may need oxygen
    administration via facemask, intubation, or a
    tracheotomy
  • Is easier to prevent than treat

81
  • Dyspnea in dogs
  • Breed-related
  • Brachycephalic dogs
  • Airway obstruction
  • Anatomy, foreign objects, postsurgical tissue
    swelling
  • Humidified oxygen can be delivered to an awake
    animal
  • By facemask, nasal cannula, E-collar, or oxygen
    cage/tent
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